HIV outbreak lessons may spur 'model response'
Indianapolis — National health officials hope to use the lessons learned from efforts to contain an HIV outbreak in southern Indiana as "a model response" for the nation in combatting future outbreaks tied to intravenous drug use, a Centers for Disease Control and Prevention leader said Tuesday.
Dr. Jonathan Mermin, the CDC's HIV prevention chief, said both he and Gov. Mike Pence hope the whole nation can benefit from the lessons learned in Scott and neighboring Jackson counties, which have seen a combined 143 HIV-positive cases since December fueled by needle-sharing among drug users.
"We want to make this a model response for how to deal with an outbreak," he said. "There's going to obstacles, there's going to be challenges but if you want to figure out what works on a small level and expand it, and what doesn't work, this is the canary in a coal mine."
Mermin and other top CDC officials visited Scott County — the center of the state's outbreak that's about 30 miles north of Louisville, Kentucky — to assess the multi-agency efforts. In a typical year, Scott County would see only about five new HIV cases.
Mermin said Indiana's HIV outbreak is unusual because it's in a rural area and most of the cases have been tied to those who injected a particular painkiller, Opana, that was crushed and mixed with water to turn it into a liquid. But the same factors found in Scott County, particularly widespread IV drug use, are present in other parts of the U.S., he said, and could eventually spark HIV and hepatitis C outbreaks in those areas.
"Quite frankly I don't expect that this is the last time we'll see an outbreak like this," Mermin said.
Officials say more than 80 percent of the people who've tested positive for HIV in Indiana's outbreak are also infected with hepatitis C.
Deputy State Health Commissioner Jennifer Walthall said health officials are still trying to overcome "fear and rumor" among drug users to get them in for testing, substance abuse treatment and other health services.
The Republican governor overrode state law March 26 in an executive order that, among other things, created a limited needle-exchange program in Scott County in hopes of combatting the outbreak. Pence approved a 30-day extension of that order last week.
As of Tuesday, 166 Scott County residents were taking part in that needle-exchange program, which has distributed more than 7,100 clean needles.
Meanwhile, Indiana's legislative session ends Wednesday, and lawmakers are nearing final decisions on a proposal to legalize needle-exchange programs to combat HIV and hepatitis C in other parts of the state.
A new draft of the bill allows areas with high rates of hepatitis C or HIV to seek approval from the state health commissioner to launch a needle exchange, but local officials would first have to prove they are in the midst of an epidemic. They also would have to prove the outbreak is spreading through IV drug use and that an exchange program would be part of an appropriate public health response.
Bill sponsor Rep. Ed Clere, R-New Albany, said he's pleased lawmakers have accepted such programs as a tool to prevent the spread of disease, but worries the criteria could prevent some at-risk counties from participating.
The bill's previous versions didn't require state approval, and called for allowing the top 23 counties with the highest rates of hepatitis C — a key indicator of needle sharing — to implement their own programs.
The change is the result of negotiations with Pence, who does not support needle exchanges as part of an anti-drug policy. Clere said the new bill is a more comprehensive approach, including drug treatment and screening programs into disease prevention.